New York likes to think of itself as one of America's most progressive states and in many ways it is. Our healthcare system, for example, is among the best in the nation. So why, in 2020, does it still suffer from gender bias? WBFO's Marian Hetherly took a look.
When it comes to health care, decisions can mean the difference between life and death. Board-certified in hematology and oncology, Dr. Beverly Schaefer understands that.
She also understands there's a national shortage of hematologists, so Schaefer goes where she's needed. She's an assistant professor of pediatrics at the University at Buffalo and sees patients at Roswell Park Comprehensive Cancer Center, Oishei Children's Hospital and WNY BloodCare in Buffalo.
"For many years, our attention was really focused on managing these very severe bleeding disorders, like hemophilia in males," she said. "The long and short of it is, bleeding issues are much more common than people expect, many people are underdiagnosed and there are clearly patients out there that also have a fair amount of bleeding, specifically with their periods, that may not know they have a bleeding disorder."
Schaefer estimated 20%-30% of these women may not know. That's important, because bleeding disorders target a variety of patients, can change over time and impact a lifetime -- from pregnancies and childbirth to menopause, surgeries and strokes.
WNY BloodCare started its S.H.E. (Specialized Hematology Experts) Clinic several years ago to help identify these women and help a gap in their continuity of care.
"We recognized two things: 1 - There were women who had a diagnosis of a bleeding disorder who needed additional extra teeth in managing their bleeding symptoms, because there was a knowledge gap among some family practitioners and some of our GYN colleagues. 2 - We also recognized that there were a lot of women, especially young women, who were dealing with really significant menses to the point that it's impacting their ability to go to school, to get through their job every day, to take care of their children, and these women warrant a work-up."
Schaefer said the S.H.E Clinic is the only clinic of its kind in Western New York and only one of a handful across the country to help manage bleeding disorders in girls and women at every age.
Overall, she believes men would grade our healthcare system a B+, but women would give it a C+.
"I think it's a combination effect that women have a higher burden, if you will, of preventative health that they need, right? Breast cancer screenings, GYN health, etc., that come at the cost of additional appointments, additional tests, additional things to navigate through the system," Schaefer said. "I also think we all know women have unique health needs. Women have often raised health concerns and we know that they have been disregarded, not listened to, brushed off for many years."
The Washington, DC-based Commonwealth Fund has been supporting health policy research and reform for more than 100 years and annually releases a ranking of U.S. healthcare systems. Its 2020 Scorecard ranks New York's healthcare system 1st among the six Mid-Atlantic states and 10th in the nation, based upon access and affordability, prevention and treatment, avoidable use and cost, healthy lives and income disparity.
Still, it found "major gaps and structural barriers" that prevent the current Primary Care system -- the foundation and gatekeeper of a person's health -- from addressing the needs of women through all stages of life.
"If we think about women's health and providing care to women, we know that care delivery tends to be very siloed and it doesn't necessarily have a gender-specific framework to really address people's needs. There's a lot of fragmentation," said Dr. Laurie Zephyrin, Commonwealth Fund vice president of Delivery System Reform. "I think maternity care is a great example. When you're pregnant, you get care. And then when you're not pregnant, you don't get care. Particularly in Medicaid, they no longer have insurance or may not have a person to go to for their care after their six or eight weeks."
Also gone are the days when a woman goes to one physician for most of her needs. More and more, women -- and men -- may see different providers in the same practice depending upon availability, or go to different specialists for different problems -- and all those providers may not communicate well with each other, particularly during transitions in life.
When Zephyrin was an OB/GYN at the Veterans Administration, she said a patient's core healthcare team included physicians, nurse practitioners and coordinators from Primary Care, Family Medicine, Internal Medicine, OB/GYN and Mental Health, who were specially trained in the needs of female veterans.
"We need reform to be able to achieve this comprehensive Primary Healthcare system. And it requires all stakeholders, not just medical providers, but also policymakers and payers and people that are entrepreneurs and starting new models in health care," Zephyrin said. "And then also we need to re-envision our training to ensure providers are adequately prepared to address women's primary healthcare needs, to partner with specialists to deliver integrated care and to deliver care in a culturally-competent manner, in a sensitive manner, that takes into account gender bias, these age biases, as well as racial biases."
The 2020 Scorecard also talks about the need for links to social services.
"It's really important that Primary Care addresses those social needs, through working with community-based organizations, through doing social needs screening as part of a Primary Healthcare visit," she said. "We have to take the next step to asking, 'Why?' Social-environmental causes impact health and health outcomes."
These causes include lack of health insurance, jobs or transportation to get to doctor appointments. She said, many communities of color also have high pollution and less access to healthy foods and grocery stores, and healthcare practices can have less revenue to expand capacity and comprehensive resources.
Zephyrin pointed to the COVID-19 pandemic as evidence that things can change very quickly if the impetus or mandate is there.
Schaefer said reform also starts at home.
"We need to be more open and upfront with young women about what is normal, what is not normal. I don't think that generalists -- so your family medicine doctors or your pediatricians -- are asking enough details to help kind of educate these women, as well," Schaefer said. "We know that for a lot of women, talking about their periods or what's happening to their body has generally been regarded as, you know, not appropriate conversation or not welcomed, even within the home. I think being a little bit more open and removing some of the those taboos can really improve communication for all parties, but also make it so that women can express themselves in a way that they can get the help they need and hopefully not be disregarded."